Affordable Care Act fails to measure up for Pennsylvania

Recently, the Supreme Court upheld the main provisions of the Affordable Care Act, most notably the individual mandate that requires Americans to purchase health insurance or pay a tax.

Many expected the ruling to bring closure to the health care debate, but in reality the 5-4 decision has presented a new challenge to voters and lawmakers. In the majority opinion, Chief Justice John Roberts clarified the court’s responsibility regarding ACA: “We do not consider whether the act embodies sound policies. That judgment is entrusted to the nation’s elected leaders.”

As Americans learn more about ACA, many are finding it to be more and more unsound. Once fully implemented, the law will extend central control and establish new levels of price-fixing that lead many experts to project that it will fall short of its promises to reduce costs and enhance the quality of care. With more than 2 million Pennsylvanians enrolled in Medicare, the state has the fourth-greatest total of beneficiaries overall. Unfortunately, these patients will be subjected to the Independent Payment Advisory Board — a cost-cutting mechanism that simply won’t work.

This panel of unelected and unaccountable officials will begin its work in 2015 to cut billions of dollars from Medicare when spending exceeds targeted levels. Given the board’s narrow authority to cut costs, many expect doctor payments for treating Medicare patients to become a primary target.

As physicians, surgeons and specialists continue to receive fewer suitable returns for their services and treatment, many will have to limit the number of Medicare patients they treat or cease providing care altogether.

The lack of doctors in Pennsylvania has been well-documented. The leaders of the Council on Physician and Nurse Supply expect the shortage in the state to climb to 20 percent from about 7 percent through the next decade. For this reason, it is important for voters and policymakers to emphasize reforms that will help improve affordability and access to care — similar to the ideas I offered in a recent visit to central Pennsylvania.

To find responsible cost savings in the insurance market, lawmakers should enhance, not weaken, access to health savings accounts and other tax-advantaged financing choices.

Ordinarily, pretax accounts would enable patients to select their coverage more carefully and also reduce the likelihood of chronic disease through enhanced preventive care. The $2,500 cap on flexible spending accounts — just one of many new or high taxes in the ACA — will only limit options for patients, families and other groups attempting to seek care in cost-effective settings.

The 2.3 percent tax on medical devices also is an unfortunate addition to the law. This excise tax that will be gradually phased in by 2018 will make life-prolonging devices more costly and reduce accessibility for patients who need them.

For those needing financial assistance, lawmakers ought to offer more refundable tax credits and vouchers. In practice, this would help patients recoup substantial portions of what they pay for services and treatment. Through the long term, it also would deliver positive results by adding new competition among providers to offer better care at more reasonable prices.

Beyond adjusting taxes, Congress could adopt a defined contribution model similar to the Federal Employees Health Benefits program for Medicare and Medicaid patients. For current beneficiaries and the millions more expected to enroll, this premium support alternative would offer a government contribution toward the cost of a health plan for a defined set of benefits.

Many of these solutions, along with allowing individuals to purchase insurance across state lines, are important to helping patients to get coverage regardless of the circumstances they might face.

Despite the president’s promise that all Americans could keep the coverage they prefer, many are facing the prospect of losing employer-sponsored coverage. Two independent surveys released in the last year indicate that at least 10 percent (and possibly as high as 30 percent) of employers plan to drop coverage as a result of the law. And fixing the broken medical liability system would save billions of dollars in the delivery of medical care.

The Affordable Care Act remains unpopular nationwide. According to a Quinnipiac University poll last month, a majority of voters oppose the insurance mandate and nearly half say that Congress should repeal the law.

Clearly, the ACA will have big implications for patients nationwide. To fashion a health care system that works best for patients, lawmakers on both sides of the aisle must work together to pass reforms that help make high-quality care more accessible and less costly overall.

Donald J. Palmisano, M.D. J.D., is a former president of the American Medical Association and spokesperson for the Coalition to Protect Patients’ Rights (www.protectpatientsrights.org/).